Jung-der Wang - Academia.edu (original) (raw)

Papers by Jung-der Wang

Critical Care, 2011

Introduction: The present study examined the median survival, life expectancies, and cumulative i... more Introduction: The present study examined the median survival, life expectancies, and cumulative incidence rate (CIR) of patients undergoing prolonged mechanical ventilation (PMV) stratified by different underlying diseases. Methods: According to the National Health Insurance Research Database of Taiwan, there were 8,906,406 individuals who obtained respiratory care during the period from 1997 to 2007. A random sample of this population was performed, and subjects who had continuously undergone mechanical ventilation for longer than 21 days were enrolled in the current study. Annual incidence rates and the CIR were calculated. After stratifying the patients according to their specific diagnoses, latent class analysis was performed to categorise PMV patients with multiple co-morbidities into several groups. The life expectancies of different groups were estimated using a semiparametric method with a hazard function based on the vital statistics of Taiwan. Results: The analysis of 50,481 PMV patients revealed that incidence rates increased as patients grew older and that the CIR (17 to 85 years old) increased from 0.103 in 1998 to 0.183 in 2004 before stabilising thereafter. The life expectancies of PMV patients suffering from degenerative neurological diseases, stroke, or injuries tended to be longer than those with chronic renal failure or cancer. Patients with chronic obstructive pulmonary disease survived longer than did those co-morbid with other underlying diseases, especially septicaemia/shock. Conclusions: PMV provides a direct means to treat respiratory tract diseases and to sustain respiration in individuals suffering from degenerative neurological diseases, and individuals with either of these types of conditions respond better to PMV than do those with other co-morbidities. Future research is required to determine the cost-effectiveness of this treatment paradigm.

Respiratory Medicine, Nov 1, 2012

Background: This study took advantage of a large population-based database of the Taiwan National... more Background: This study took advantage of a large population-based database of the Taiwan National Health Insurance (NHI) to investigate the epidemiology of idiopathic pulmonary fibrosis (IPF) in Taiwan.

Epidemiology, Jul 1, 2004

The aim of this programme is to provide a single system for coordinating the collection, collatio... more The aim of this programme is to provide a single system for coordinating the collection, collation, analysis and dissemination of information on environmental incidents occurring in Scotland, with the objective of using the information to identify priorities for further epidemiological investigation and highlight opportunities for improving active interventions, control, prevention, education, or policy development. Methods: Surveillance is based on active and passive data collection from local and national agencies. This is supplemented by other ad-hoc and media reports of incidents. The unique functionality of system is based on an electronic reporting option and internet-based User Interface for the provision of timely local, regional, and national feedback, to facilitate the investigation and follow-up of incidents associated with human exposure and possible adverse health outcomes. Results: 571 reports were received in 2002 from 51 participants (80% return rate). 107 (20%) returns gave a report of at least one incident. 280 satisfied the criteria for inclusion in the dataset, of which 112 (40%) were chemical incidents. The principal pathway for exposure to chemical agents was via the airborne route (66%); 31% of chemical incidents involved land and 3% involved water. Most incidents occurred in commercial locations (20%), with industrial, open space, residential and transportation related locations each accounting for between 10% and 16% of incidents. Incidents involving asbestos were associated principally with building-material fires. Leaks from refrigerators were the principal cause of incidents involving ammonia, whilst breakages of thermometers/sphygmomanometers identified as the principal causes of incidents involving mercury. Of the 280 incidents in the dataset, 161 (58%) involved microbiological agents. Waterborne exposure accounted for 99% of microbiological incidents. Blue-green algae (BGA) is the major microbiological agent reported. Discussion: The system has been demonstrated as a practical method of collating reports and providing feedback of incidents involving environmental agents that have the potential to cause harm to human health. The system captures information on chemical, biological and radiological incidents occurring in the airborne, waterborne and landborne environments. The ad-hoc and media monitoring has proven to be a valuable supplementary source. However, analysis of the incident data for 2002 has shown that Public Health agencies are aware of only a minority of incidents that occurred. The system is being further developed for the real-time notification and epidemiological follow-up of incident involving exposure to hazardous materials and their health impact.

International Journal of Environmental Research and Public Health

This research examines whether the Coronavirus disease 2019 (COVID-19) did harm to the population... more This research examines whether the Coronavirus disease 2019 (COVID-19) did harm to the population’s health through comparing the changes in the life expectancy of Canadians with those of Australians over the period from March 2019 to February 2021 by using a difference-in-differences (DID) estimation method. We found that the pandemic did cause differences in life expectancies between Canada and Australia, probably because of different initial control policies for COVID-19. This study uses the indicator of disability-adjusted life years (DALYs) to measure the societal health burden, which was corroborated by estimating temporal productivity loss (TPL) and permanent productivity loss (PPL) based on the human capital approach (HCA) using data from Health Canada. The societal health burden in Canada amounted to 6.493 DALYs per 1000 male persons and 5.316 DALYs per 1000 female persons. The economy’s permanent productivity loss was around USD 5.3 billion, while the temporary productivity...

International Journal of Environmental Research and Public Health, 2022

Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, ... more Infection with COVID-19 could result in lockdown, quarantine of contacts, absenteeism from work, and temporary productivity loss. This research aims to calculate (1) how the pandemic affects on-the-job probability and earnings for the working population, and (2) how much productivity loss is associated with self or a family member sick with COVID-19. Based on data collected from the U.S Research and Development Survey (RANDS), this research projects the relationship between on-the-job possibility and age of the index group and calculates the employment possibilities of the index group relative to the healthy group, namely the employment ratio. The weekly loss of productivity, presented by earnings, associated with COVID-19 for groups aged 18–44 years and 45–64 years was calculated, since the 18- to 64-year-old population is an economy’s active workforce. Analytical results indicate that the older the age group, the lower the on-the-job possibility, and the higher the weekly producti...

International Journal of Environmental Research and Public Health, 2021

Health services provided through the telecommunications system aim to improve the population’s he... more Health services provided through the telecommunications system aim to improve the population’s health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries’ experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3–5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing...

The Kaohsiung journal of medical sciences, 2002

There were several reports about elevated blood lead levels in lead battery workers. However, the... more There were several reports about elevated blood lead levels in lead battery workers. However, their subjects came from only one or several plants. We visited all the 23 registered lead-acid battery plants in Taiwan and collected their health examination records in 1992, the blood lead analyses of which were completed in 3 medical college hospitals. In total, we have obtained 1726 records. The average blood lead concentration was 37.1 ug/dl, and 37% of blood lead levels were more than 40 ug/dl (action level). The overall participation rate for health examination among employees was 69.4%. The participation rates were different among both plant sizes and job titles. Assuming that there was no peculiar variation within the four working zones (plate manufacture jobs, assembly jobs, part-time exposure jobs, and office jobs) in each plant, and that blood lead levels of our samples were stable after deleting newly hired workers, we estimated that the blood lead distributions of 2486 employ...

Injury Prevention, 2021

BackgroundThe objectives of this research were to determine the savings of loss-of-life expectanc... more BackgroundThe objectives of this research were to determine the savings of loss-of-life expectancy (LE) and lifetime medical costs (LMC) from prevention of spinal cord injuries (SCI) in Taiwan.MethodsFrom the claims database of Taiwan National Health Insurance, we identified 6164 adult patients with newly diagnosed SCI with permanent functional disability from 2000 to 2015 and followed them until the end of 2016. We estimated survival function through the Kaplan-Meier method and extrapolated it to lifetime.ResultsFor the SCI cohort, the LE and loss-of-LE were 17.6 and 13.3 years, respectively, while those for SCI with coding of external causes (E-code) were 18.1 and 13.0 years, respectively. For the SCI cohort with E-code, the loss-of-LE of motor vehicle (MV)-related SCI was significantly higher than that of fall-related SCI. In young and middle-aged patients with SCI with E-code, the loss-of-LE of MV-related paraplegia was significantly higher than that of MV-related quadriplegia a...

Applied Research in Quality of Life, 2016

The provision of health services via telecommunications technologies can complement face-to-face ... more The provision of health services via telecommunications technologies can complement face-to-face healthcare provision, and thus has the potential not only to improve access to healthcare, but also improve the quality of care provided. The provision of healthcare aims to sustainably improve the population's wellbeing, and this should be one focus of governments (WHO 2012). In order to assess the health and wellbeing of a population and track changes over time, this research proposes the concept of Butility-adjusted life expectancy^(UALE), which adjusts the lifetime survival function with a more comprehensive utility measure that combines the utilities from both consumption and health. Our outcome measures permit us to examine the lifetime utility after re-allocating medical resources. The estimated personal welfare would increase by 8.75 utility-adjusted life years (UALYs) when the share of telehealth expenditure to GDP rises, until economic growth and social welfare maximization are achieved. Our findings reflect that appropriate investment in telehealth improves health and supports economic development, and could be a viable approach for nations with aging populations by reducing the cost of their healthcare systems. This research highlights new opportunities and challenges in assessing the provision of telehealth.

作者:Hung, MC (Hung, M. C.)[ 1 ] ; Lee, LJH (Lee, L. J. H.)[ 2 ] ; Jeng, JS (Jeng, J. S.)[ 3 ] ; Wa... more 作者:Hung, MC (Hung, M. C.)[ 1 ] ; Lee, LJH (Lee, L. J. H.)[ 2 ] ; Jeng, JS (Jeng, J. S.)[ 3 ] ; Wang, JD (Wang, J. D.)[ 4 ] Objectives Few studies have estimated the dynamic changes and lifetime scores of quality of life (QOL) among different types of ischemic stroke. The aim of this study was to quantify these to assist clinical decision. Methods The hospital-based cohort, which consisted of 10,102 patients with first-ever ischemic stroke during 1995-2007, was classified into 5 types: large artery atherosclerosis (LAA), lacune, cardioembolism, other determined, and undetermined etiologies. After linking with the National Mortality Registry 1995-2008, survival function were determined and extrapolated over a 600-month period based on the survival ratio between the patient's and age- and sex- matched reference group's survival as estimated by a semi-parametric method and hazard functions taken from the vital statistics of Taiwan. WHOQOL-BREF questionnaire were administered on ...

Objective: To examine transitions to different care settings or death after receiving prolonged m... more Objective: To examine transitions to different care settings or death after receiving prolonged mechanical ventilation (PMV), and investigate factors associated with post-PMV trajectories of care and mortality. Methods: We used secondary and prospectively collected data from the National Health Insurance Research Database and the death certificates database of Taiwan for a national representative sample of 35,671 new PMV patients in 2002-2007. We extracted data from patients' historic inpatient records and medical orders to construct records regarding all post-PMV transitions to different care settings or death, and used multinomial logit regression to determine factors associated with post-PMV probabilities of moving to various care settings or death. Results: At the PMV onset, almost 60% of patients were in intensive care units (ICU), 26% were in general wards, and 14% were in respiratory care centers. We observed 130,684 transitions among these patients. Among patients in an ...

International Journal of Occupational and Environmental Health, 2008

Female workers in the semiconductor industry have higher risks of subfertility and spontaneous ab... more Female workers in the semiconductor industry have higher risks of subfertility and spontaneous abortion, but no studies exploring male-mediated developmental toxicity have been published. This study aimed to investigate whether the offspring of male workers employed in the semiconductor manufacturing industry had an increased risk of death with congenital anomalies. The 6,834 male workers had been employed in the eight semiconductor companies in Taiwan between 1980 and 1994. We identified the live born children with or without congenital anomalies of the workers using the National Birth and Death Registries from the Department of Health, Taiwan. Multiple logistic regression models were used to estimate the odds ratios (OR) of birth outcomes and deaths, controlling for infant sex, maternal age, and paternal education. A total of 5,702 children were born to male workers during the period 1980-1994. There were increased risks of deaths with congenital anomalies (adjusted OR, 3.26; and 95% confidence interval [CI], 1.12-9.44) and heart anomalies (OR, 4.15; 95% CI, 1.08-15.95) in the offspring of male workers who were employed during the two months before conception. We found evidence of a possible link between paternal preconception exposure of semiconductor manufacturing and an increased risk of congenital anomalies, especially of the heart. The possible etiological basis needs to be corroborated in further research.

Clinical and experimental rheumatology

This study was conducted to determine how disease activity affects quality of life (QOL) and its ... more This study was conducted to determine how disease activity affects quality of life (QOL) and its interaction with functional impairments, and disease duration in patients with rheumatoid arthritis (RA). This cross-sectional study enrolled 230 patients with RA from a rheumatology clinic in Taiwan and 227 healthy controls matched according to age, sex, marital status, and education. QOL was measured using the Taiwan version of the short form of the World Health Organisation Quality of Life (WHOQOL-BREF) questionnaire. Activity of RA was assessed by the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28). Functional disability was assessed by the Health Assessment Questionnaire (HAQ). Multiple regression analyses were performed to explore independent effects and interactions among DAS28, HAQ, and duration after controlling demographic factors. A higher HAQ score, longer duration of disease, and higher DAS28 score were independently associated with lower...

Occupational and Environmental Medicine, 2010

Radiation-induced cytogenetic damage in somatic cells has raised concern that low-dose ionising r... more Radiation-induced cytogenetic damage in somatic cells has raised concern that low-dose ionising radiation can also damage germ cells and influence gamete production and/or function, resulting in decreased fertility. Time to pregnancy (TTP) was used to investigate whether exposure to gamma-radiation affected fertility among the residents of cobalt-60-contaminated buildings in Taiwan. This was a retrospective pregnancy-based study of 357 pregnancies born to 124 exposed couples. Both the cumulative dose and the dose rate for each pregnancy was estimated based on a physical dose reconstruction programme. The comparison population consisted of 612 pregnancies born to 225 couples randomly sampled from the Taiwan general population. Information on TTP was collected by personal interviews. Fecundability ratios (FRs) were calculated with a discrete proportional hazards model. For exposed mothers, fertility decreased significantly when unprotected intercourse began during the period of living in the radiation-contaminated buildings (FR 0.75, 95% CI 0.61 to 0.92). The effect was borderline significant for fathers (FR 0.83, 95% CI 0.68 to 1.02). There was evidence that prolonged TTP was associated with the rate of exposure for both mothers and fathers (tests for trend: female, p=0.0006; male, p=0.03), especially evident for dose rates > or =10 mSv/year (female, FR 0.60, 95% CI 0.43 to 0.84; male, FR 0.68, 95% CI 0.49 to 0.96). Our findings suggest that exposure to low-dose ionising radiation of cobalt-60-contaminated buildings may decrease fertility, especially in females. Fertility declined with increasing concurrent dose but not with cumulative dose.

Occupational Medicine, 2008

Conclusions There is no convincing evidence that female workers employed during the periconceptio... more Conclusions There is no convincing evidence that female workers employed during the periconceptional period in the semiconductor industry had higher risks of having adverse birth outcomes or death due to congenital malformations. However, prospective research is warranted to confirm these findings.

Journal of Occupational & Environmental Medicine, 1998

Vinyl chloride (VC) workers are known to be at risk for development of liver angiosarcoma, a rare... more Vinyl chloride (VC) workers are known to be at risk for development of liver angiosarcoma, a rare tumor. Previously, more than 80% of VC workers with liver angiosarcoma have been found to have an Asp-13 c-Ki-ras oncogene mutation, and more than 50% of VC-exposed workers without liver tumors were found to have Asp13-Ki-ras oncoprotein in their plasma. Some workers in Taiwan had also been exposed to VC, and some have contracted liver tumors. In this study, we used enhanced chemiluminescence Western blotting to detect Asp13-p21-Ki-ras in the sera of VC-exposed workers in Taiwan. There were 14 of 113 (12.4%) VC workers positive for the Asp13-Ki-ras oncoprotein in plasma, but 0 of 18 controls were positive. There were 10 of 69 (14.5%) plasma-positives among the more highly exposed (> 1000 ppm-months) workers and 4 of 48 (9.1%) plasma-positives among the lesser exposed (< or = 1000 ppm-months). Compared with the unexposed controls, the odds ratios (and 95% confidence intervals [CI]) for plasma-positivity were 4.11 (95% CI = 0.21, 80.4) in the lower-exposed workers and 6.53 (95% CI = 0.37, 116.9) in the higher-exposed workers, and there was a linear trend between exposure and plasma-positivity (P = 0.073). After adjusting for age and drinking status, the odds ratios (and 95% CIs) were 1.64 (95% CI = 0.17, 15.8), and 2.65 (95% CI = 0.42, 16.8), respectively, and there was a significant linear trend between exposure and plasma-positivity (P = 0.048). In summary, Asp13-Ki-ras oncoprotein can be found in the plasma of VC workers in Taiwan, and a significant dose-response relationship exists between plasma oncoprotein expression and VC exposure.

Journal of Occupational & Environmental Medicine, 1999

Vinyl chloride (VC) workers are known to be at risk for development of angiosarcoma of the liver ... more Vinyl chloride (VC) workers are known to be at risk for development of angiosarcoma of the liver (ASL), a rare tumor. Previously, a study of p53 gene mutations in tumors of VC-exposed workers found that 50% of liver angiosarcomas contained such mutations. Mutant p53 oncoprotein and anti-p53 antibodies can also be found in the sera of ASL patients and VC-exposed workers without cancer. Workers in Taiwan have also been exposed to VC, and some have contracted liver tumors. In this study, we used enzyme-linked immunosorbent assays to detect mutant p53 protein and anti-p53 antibodies in the plasma of VC-exposed workers in Taiwan. Thirty-three of 251 (13.2%) VC-workers tested positive for the p53 overexpression (10% with positive mutant p53 protein and 3.6% with positive anti-p53) in their plasma, but only 2 of 36 controls (5.6%) tested positive (2.8% with positive mutant p53 protein and 2.8% with positive anti-p53). There was a significant association between cumulative VC exposure concentration and positive p53 expression (P = 0.032) among VC workers after we adjusted for age, hepatitis, drinking, and smoking status. In summary, P53 overexpression (mutant p53 protein or anti-p53 antibody) can be found in the plasma of VC workers in Taiwan, and a significant dose-response relationship exists between plasma p53 overexpression and VC cumulative exposure concentration.

The Journal of Infectious Diseases, 2004

Background. Taiwan established a nationwide surveillance system for human immunodeficiency virus ... more Background. Taiwan established a nationwide surveillance system for human immunodeficiency virus (HIV) infection in 1989 and adopted a policy to provide all HIV-infected citizens with free access to highly active antiretroviral therapy (HAART) beginning in April 1997. This provided an opportunity to determine the effect of the widespread use of HAART on the evolution of the HIV epidemic. Methods. We analyzed national HIV surveillance data. The HIV transmission rate was estimated by use of an exponential model of HIV epidemic evolution, with statistical projection over the interval between infection and detection to fit the surveillance data. Results. By the end of 2002, the cumulative number of HIV-infected citizens in Taiwan had reached 4390 (0.019% of the total population). After free access to HAART was established, the estimated HIV transmission rate decreased by 53% (0.391 vs. 0.184 new cases/prevalent case-year [95% confidence interval, 31%-65%]). There was no statistically significant change in the incidence of syphilis, in the general population or among HIV-positive patients, during the same period. Conclusion. Providing free HAART to all HIV-infected citizens was associated with a 53% decrease in the HIV transmission rate and contributed to the control of the HIV epidemic in Taiwan. A higher HIV load is one of the major determinants of the risk of HIV transmission [1-3]. Highly active antiretroviral therapy (HAART) [4, 5], which profoundly suppresses HIV-RNA levels in body fluids [6-8], not only remarkably prolongs the survival of treated patients [9, 10] but also reduces rates of mother-to-child perinatal transmission [11, 12] and heterosexual transmission [13], according to the results of clinical studies. In theory, the widespread use of HAART could lead to a reduction in the rate of HIV transmission in the entire population and contribute to the control of the HIV